ENRICO CARLO PAGULAYAN GONONG Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125054087

License Status

CANCELLED

Business

First Name

ENRICO CARLO

Middle

PAGULAYAN

Last Name

GONONG

Business Name

ENRICO CARLO PAGULAYAN GONONG

Original Issue Date

07/01/2008

Effective Date

07/01/2008

Expiration Date

06/30/2011

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/06/2008